- What is diabetic ketoacidosis?
- What to expect when recovering from diabetic ketoacidosis
- How long does it take to recover from diabetic ketoacidosis?
- Tips to speed up recovery from diabetic ketoacidosis
- What are the long-term effects of diabetic ketoacidosis?
- How do you know if DKA is resolved?
- What is the fastest way to get rid of ketones?
If you have diabetes mellitus, you probably have heard of the term diabetic ketoacidosis from your doctor.
Diabetic ketoacidosis (DKA) is one of the most dangerous complications of diabetes mellitus, especially in type 1 diabetes (the autoimmune kind of diabetes frequently diagnosed in younger people).
Two-thirds of diabetic ketoacidosis incidences happen in people with type 1 diabetes compared to one-third in those with type 2 diabetes.
Any medical conditions that exert stress on our body can precipitate diabetic ketoacidosis; the most common cause is an infection, such as urinary tract infection and gastroenteritis.
Researchers analyzed the incidence and economic burden of diabetic ketoacidosis in the U.S. told a worrying result– the trend of hospitalizations due to diabetic ketoacidosis has been increasing in the last decade.
In 2017, based on another study, a total of 220,340 U.S. residents had a diagnosis of diabetic ketoacidosis, accounting for 0.6% of all hospitalized cases.
The average cost of treating diabetic ketoacidosis is around $30k per person for a mean hospital stay of 3 days.
What is diabetic ketoacidosis?
Diabetic ketoacidosis is the most common life-threatening diabetic crisis. People with diabetes mellitus need insulin to control their blood glucose level, particularly people with type 1 diabetes, since their bodies cannot self-produce insulin.
Insulin helps glucose, the energy source for all cells’ functions, enter the cells. When our body lacks insulin, it begins to break down fat to fuel the cells and produce a side product called ketones.
Ketones build up in the bloodstream. If it’s left untreated, diabetic ketoacidosis can eventually happen.
In diabetic ketoacidosis, your blood glucose level will be very high (more than 11.0 mmol/L), and your blood becomes acidic (pH less than 7.3), accompanied by a low alkaline bicarbonate ion concentration of less than 15.0 mmol/L.
Another essential component in a diabetic ketoacidosis diagnosis is a high ketone level in the body, which is evidenced by a blood ketone level of more than 3.0 mmol/L and the presence of ketones in the urine (2+ and above).
Symptoms of diabetic ketoacidosis
Diabetic ketoacidosis symptoms usually start slowly and worsen over 24 hours. The symptoms include:
- The urge to urinate more than often
- Extreme thirst
- Feeling sick or having no energy
- Abdominal pain
- Nauseous and vomiting
- Fruity-scented breaths (like pear drop sweets or nail varnish)
- Shortness of breath
- Loss of consciousness
If you have the above symptoms, you should self-test your blood sugar and ketone levels. Both test kits are available in pharmacies.
Anytime your test results are out of the aforementioned normal range, you should go to the nearest A&E or call an ambulance immediately.
Repeat the testing in 4 to 6 hours if the reading is normal, and look out for any newly emerged diabetic ketoacidosis signs and symptoms. If there are any, you should seek emergency care in the shortest time possible.
What to expect when recovering from diabetic ketoacidosis
If you have diabetic ketoacidosis, you will receive emergency treatment and will usually be admitted into the ward. To help you recover from diabetic ketoacidosis, you can expect the following treatments:
1) Blood tests
Your doctor will likely insert a needle in your hand or arm for blood-taking and giving medication purposes. Some blood samples will be taken and sent to the labs.
People with diabetic ketoacidosis are in a severe dehydration state. Therefore, you will be put on drips for continuous fluid infusion into your bloodstream. A large amount of fluid can dilute the excess sugar and brings down the acidity of your blood.
3) Electrolytes replenishment
Electrolytes are minerals that regulate various body physiological actions, especially in the nerves, muscles, heart, and brain. Insulin deficiency can reduce the level of electrolytes in your body.
You will receive potassium fluid, the electrolyte most affected in diabetic ketoacidosis, through the needle on your hand or arm.
Solve the root cause– gives your body what it needs. Unlike your usual insulin injection, in diabetic ketoacidosis, you will receive insulin via infusion through the needle inserted into your blood vessels.
The insulin will go into your bloodstream and circulate to your whole body. This effectively reverses the conditions that cause diabetic ketoacidosis.
Once your diabetic ketoacidosis is resolved (we will see this later), you will switch back to your regular insulin injection.
5) Medications for underlying illnesses
For example, antibiotics for diabetic ketoacidosis triggered by an infection.
Usually, you will be asked to fast during a diabetic ketoacidosis crisis until your blood results return to normal and you are fit to eat and drink orally.
How long does it take to recover from diabetic ketoacidosis?
Successful treatment can usually resolve an episode of diabetic ketoacidosis in 24 to 48 hours. However, if complications have occurred, you may need a more extended period to recover from this diabetic crisis.
The sooner you receive emergency care, the less detrimental effects of diabetic ketoacidosis are to your body.
The most sinister effects of diabetic ketoacidosis include the following:
- Cerebral edema (brain swelling)
- Severe hypokalemia (deficient potassium levels) which can lead to weakness of muscles, gut paralysis, respiratory failure, and cardiac arrhythmia (irregular heartbeat)
- Multi-organ failure, including heart, lungs, and kidney
- Diabetic coma (loss of consciousness)
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Tips to speed up recovery from diabetic ketoacidosis
Diabetic ketoacidosis is a dreadful condition for people with diabetes mellitus. Here are some tips to accelerate your recovery process from this diabetic crisis:
- Follow instructions from your healthcare provider. Take all the medications given at the correct time. Adhering to professional medical advice helps you get out of diabetic ketoacidosis safely.
- Frequently check your blood sugar and ketone levels. If you stay in the ward, your nurses will take care of this; otherwise, you should check your blood glucose and ketone levels hourly. You may measure blood or urine ketones using a blood ketone meter or urine ketone strips.
- Drink a lot of fluids to reduce dehydration. Once you are allowed to tolerate it orally, drink more water to stay hydrated. This is especially important if you experience vomiting or diarrhea.
- Eat the usual appropriate meals. Resume your normal food intake once the diabetic crisis is resolved. If you are taking insulin, be sure to take the appropriate amount and type of food as per your healthcare provider’s recommendation.
- Do not exercise during diabetic ketoacidosis. Physical activity can accumulate ketones in your body, which worsen the condition. Consult your healthcare provider to know when you can start exercising again.
What are the long-term effects of diabetic ketoacidosis?
Besides causing immediate life-threatening consequences, diabetic ketoacidosis brings significant long-term adverse effects from physical, psychological, and financial aspects. These impacts include:
- Organs impairment includes chronic kidney disease, pulmonary edema, cardiac arrhythmias, and injury to the brain and liver.
- Higher risk of having blood clots (deep vein thromboses)
- Fungal infection (mucormycosis)
- Expensive medical expense
- Decreased quality of life
- Fear of recurrent diabetic ketoacidosis and death
In a retrospective cohort study conducted among 386 diabetic ketoacidosis patients, mortality was 8% and 18% at one month and one year, respectively. After five years, only 65% of the patients survived. Older age and a more severe state of diabetic ketoacidosis are related to a higher risk of death.
How do you know if DKA is resolved?
According to the Joint British Diabetes Societies for Inpatient Care guideline, diabetic ketoacidosis is considered resolved when ketones drop below 0.6 mmol/L (or 10.81 mg/dL), and blood pH is back to normal, which is higher than 7.3.
After correcting your blood biochemical profile, you should also experience relief from your diabetic ketoacidosis signs and symptoms.
What is the fastest way to get rid of ketones?
The best and fastest way to remove excessive ketones from your body is the simplest way– drinking water.
As mentioned before, diabetic ketoacidosis puts your body in a severe dehydration state due to increased urination frequency. By drinking a large amount of water, your body can regain fluid volume loss.
At the same time, rehydration helps dilute the acidic and sweetened blood full of glucose and ketones. Fluid replenishment stops further loss of electrolytes in diabetic ketoacidosis as well.
Examples of electrolytes include potassium, sodium, and chloride. All of them are necessary substances to enable the normal functioning of our cells and organs, specifically the heart, nerves, and muscles.
As the saying goes, prevention is better than cure. If you think diabetic ketoacidosis is about to happen to you, it is best to monitor your blood glucose level closely and, if possible, the level of ketones in your body as well.
Drink more water, do not exercise, and take your insulin at a higher dose as briefed by your healthcare provider– ask them if you are unsure of what a “sick day rule” is.
Diabetic ketoacidosis is scary, but it is preventable. Understand diabetic ketoacidosis definition, identify its signs and symptoms and take proper actions, as discussed in this article, to stop the befall of this life-threatening diabetic crisis.
Most importantly, communicate with your diabetes care provider to learn more about your health condition and treatment plan in the long term.